Longing for the "Good Old Days" in Mental Health

Stanton Peele has written an amazing article, "Nervous Breakdown: Remember When People Used to Overcome Mental Illness?"  His point?  Our treatment of mental illness may have been better in the past, before modern psychiatry and Big Pharma.  

Granted, our treatment of mental illness in the past included lobotomies and Thorazine.  Still, Peele makes an interesting point - that people do have some ability to recoup from a "nervous breakdown" if given the time and support.  Putting people on medications for the rest of their lives may be a benefit for the pharmaceutical companies and the psychiatrists paid to administer and monitor these medications, but are they the panacea they promise?  And what is the cost?  The antipsychotics, in particular, are heavy duty tranquilizers which numb a person's emotions and dull their thoughts.  The chances of a person returning to a fully functioning life on these medications is slim.  What if clients were provided more support and therapy instead of making medication the first line of treatment?

It's an interesting read.




Human Connection vs. Addiction

I recently watched an interesting Ted talk, Everything You Think You Know About Addiction is Wrong by Johann Hari.  Great stuff.  Hari makes some interesting points.  Among them:

Simply giving someone opiates can't turn them into a drug addict.  

Our culture has taught us that giving someone opiates will cause them to become an addict.  I've known doctors who worry about prescribing adequate pain medication because they don't want to "make" the patient an addict.  As a result, doctors typically under-medicate pain.  I personally think the under-prescribing of pain medications may contribute to addictive thinking and behavior, but I've never known it to cause addiction.  What's the difference?  Under-medicating patients tends to make them more anxious about being treated adequately for pain, so they may begin to hoard medications or skip doses so they can double up later, etc. because they don't trust the doctor to adequately control their pain.  Addiction, on the other hand, is not about controlling pain, but about feeling the high.  Drug addicts skip doses and hoard their medications so they can take large doses all at one time to get the high.  However, the under-prescribing of pain medications now has a healthy person thinking and behaving like a drug addict - out of fear.

Think of someone you have known who has had a lot of surgery - and the heavy duty pain medications that go with it.  Hari gives the example of grandma having hip replacement surgery.  Grandma completes the surgery, recovers and is not an addict.  

So what is the difference between someone who is exposed to opiates and becomes an addict - and someone who does not?  Hari maintains it is the quality of their lives.

Rats can't be made into heroin addicts - if given other options

Hari cites a study of rats in cages who had a choice between water laced with heroin or regular water.  Rats living in barren, empty cages always chose the heroin water.  However, researchers found if they housed the rats in cages equipped with all the things rats love, toys, other rats to play with, comfortable beds to sleep in, etc. (a kind of "rat park" as Hari calls it), the rats don't choose the heroin laced water.  Point?  Rats with full and happy lives don't choose heroin.

Why is this important? 

We are finding that human connection and a healthy "rat park" is what keeps humans from becoming addicted.  People with full and healthy lives don't want to be intoxicated or numbed.  They want to be aware so they can enjoy their lives.  

What does this mean for our treatment of the addicted?

The criminalization of drugs prevents people from re-entering society.  A person convicted of drug charges has a criminal record.  This labels them as criminals, shames and humiliates them, associates them with a criminal element in society, prevents them from obtaining employment and housing and impairs their healthy relationships.  It effectively hampers them from re-entering human society as effectively.  They are shamed and stigmatized and left with little to get out of bed for.  Being imprisoned severs their connections with family and friends.  

Perhaps we should treat the addiction rather than punishing the addict -  keeping them in society instead of removing them from it, requiring them to participate in drug treatment instead of locking them away with criminals, requiring them to work instead of hampering their employment, teaching them to parent instead of removing them from their children - this might be a better solution.

Psychopaths, Autism, Empathy and Mirror Neurons

V. S. Ramachandran is a neurologist and an author.  If you're interested in the mysteries of the human brain I highly recommend you read any of his books.  In a lecture from 2006* he talks about "mirror neurons".  Scientists have found motor neurons fire in a monkey's brain when the monkey reaches for a peanut.  Interestingly, a subset of these neurons, called mirror neurons, fire when the monkey watches another monkey reach for a peanut.  Mirror neurons in humans work the same way.  The motor neurons fire when we poke a person with a needle, but a subset of these neurons, the mirror neurons, fire when we witness someone else being poked with a needle.  These mirror neurons appear to be our way of empathizing with another.  They are the mechanism by which we put ourselves in someone else's shoes and are the basis of our empathy.  As such, they may be the basis for human ethics.  

Ramachandran notes that autistic children appear to suffer from mirror neuron dysfunction, resulting in a lack of empathy and an inability to relate to others.  A separate article about mirror neurons notes that psychopaths and sociopaths have impaired functioning of the mirror neurons.  Psychologists have known for some time that people with antisocial personality disorder (the clinical term for sociopaths and psychopaths) feel no empathy and have no regard for the rights of others.  Narcissists too share these traits.  Though they both see themselves as human, they fail to see the humanity in other people.  They regard people in their lives as objects to be manipulated to get what they want, not as human beings.   People with antisocial and narcissistic personality disorders are unable to relate to other people as being like themselves.  People with these personality disorders feel no empathy for other people, they cannot identify with other people and they feel no remorse when they cause harm to others.  

We knew that a horribly neglectful or abusive childhood could result in antisocial or narcissistic personality disorder, but we didn't know the mechanism.  It is now believed that such a childhood can result in these neurons not being used, so they fail to develop normally.  This failure to develop in childhood results in an adult with dysfunctional mirror neurons and the resulting antisocial or narcissistic traits.  If these neurons can be rendered dysfunctional by lack of use, perhaps we can develop interventions which use them, restoring their functionality and healing people with these personality disorders.

It's an interesting theory.

* Ramachandran's part of the lecture begins about 39 minutes into the presentation.  


Resentment is Like Drinking Poison

 “Resentment is like taking poison and waiting for the other person to die.” 

Malachy McCourt

I once saw a documentary about several men who were wrongfully imprisoned for crimes they did not commit.  They had each been imprisoned for years, until the court system found they were innocent and released them.  Some of the men were consumed by the injustice committed by the legal system and spent their lives protesting and exposing it.  Others were morose and jaded and cynical.  Eaten alive by the resentment they refused to go on with their lives and sat, stewing, unwilling to trust, to be happy, to rejoin life, to be happy again.  

But the last one caught my attention.  He had met a woman while in prison and fallen in love.  Upon his release, they were married.  He found a job, bought a house and went on with his life.  Not without scars.  Not without trauma, hurt, betrayal and pain.  He embraced all of those.  He talked openly about how negatively the experience had affected him and what it had cost him.  But he made a conscious decision not to let it steal another day of his life.  He had forgiven the criminal justice system for the wrong they had done to him - and moved on.  

I think this can also be said of people leaving unhealthy relationships and survivors of childhood traumas.  At some point you make a choice about the wrong that was done to you.  Do you hang on to it or let it go?  Do you forgive?

"If I forgive them, I have to forget what they did and I never want to forget what they did to me."

Many people think that forgiving is about forgetting.  It's not.  If you were hurt by an abuser, or a partner who was violent, or a relationship with someone who was toxic, you want to forgive, but not forget.  You remember what was done to you to keep yourself safe.  You need to remember what they did so you don't open yourself up to let them hurt you that way again.  You learn from it to prevent it from happening again.  Forgiveness is not about forgetting, it's about letting it go.  I have seen people who were wronged hold onto to the anger, hurt and betrayal long after the deed is done.  The person who hurt them has moved on with their life.  But the victim is consumed with rage, fear, hurt, betrayal.  They walk around seething and fuming.  Their lives are consumed with it.  

I am not advocating that you not feel the pain.  Of course you feel the pain.  Embrace it, immerse yourself in it, feel it completely and totally and experience all the emotions is brings.  But then, let it go.  To hang on to it is to allow the person who wronged you to continue to have control over you, your feelings, your life.  You give them power over your life, over your emotions, over you.

"If I forgive them, they get away with it."

Forgiveness is not about letting them get away with it  It's about letting you get on with your life.  For a moment, or even for years, they were able to affect your emotions, your thoughts, your life.  But forgiving is about letting go and taking back your emotions, your thoughts, your life.  It's about being free from toxic influence or abuse.  It's about deciding how you want to feel, what you want to think and how you want to live instead of allowing your emotions, your thoughts and your life to be hijacked by another person's abuse or drama.  

For those who would; revel in your failure, try to hurt you, seek to oppress you, cause you to suffer, think you are less, care nothing about you, seek to destroy you...

Happiness is the best revenge.  

 Success, the best redress. 

On Tolerance

It seems to me that tolerance for others is closely related to tolerance for ourselves.  It we are compassionate and forgiving of ourselves, we tend to be the same way with others.  If we are hypercritical and judgmental of ourselves, we tend to be the same way with others.  That inner critic who criticizes everyone else is a reflection of the inner dialogue we are having with ourselves.

Learning to accept ourselves may be the first step in accepting others.

Likewise, I think people are less tolerant of people who engage in behaviors which they find repugnant in themselves.  I'm reminded of the cliche of the newly sober man or woman who is intolerant of anyone drinking around them.  I once asked my mother what she disliked most in other people.  She spent 3 minutes telling me how much she disliked people who talked and talked and talked, repeating themselves over and over and over.   And I smiled.

Working on our own program and addressing our own shortcomings may be the key to accepting the fallibility of others.


How Could I Be So Stupid?

Have you been manipulated, lied to, controlled by a toxic person?  The person may be a psychopath (antisocial), a narcissist or a borderline.  They've betrayed, exploited and misled you.  They've seduced you with their charm and beguiled you with their lies.  They've stolen your money, your life, your heart.  And you're left wondering, "How could I have been so stupid?"

I am reminded of an old Spanish saying that I absolutely love,

"The lion believes that all are like him."

An honest person expects people to treat them honestly.   Someone who is not a thief may not lock up their belongings, because it does not occur to them that other people would steal from her.

Naturally, you need to check yourself for a susceptibility to flowery speech and manipulation.  If you have a low self esteem you may be especially susceptible to someone showering you with compliments while they simultaneously mistreat, dismiss or disregard you.

But aside from that, one of the struggles of people who are dealing with psychopaths, narcissists or other manipulative people is the nagging question, "How could I not have seen this?", "How could I have been so stupid as to pick out this person?", "Why am I so gullible?" If you are really kicking yourself thinking you were inordinately naive or dumb for having been duped so completely you might find the following explanation helpful.

I found this description of psychopathic manipulation in an article on manipulation and controlling behaviors:

Psychopaths know well and have nothing but disdain for the characteristics of good-natured people and use those very qualities — including most people’s willingness to trust and afford others the benefit of the doubt and the conscientiousness most people have and discomfort they typically have when they think they might be the cause of anyone else’s pain — against them. Possessing a narcissism so malignant (“Narcissism: Pathological Self-Love”) that they consider truly decent folks as inherently weak and inferior, they feel “entitled” to prey on such folks, and deliberately play on their sensitivities and sensibilities to con, exploit, and otherwise victimize them. Worst of all, they do these things for the pure pleasure of it. It’s not fear, insecurity or emotional pain that drives them, just an incapacity to care and a craving to dominate.

Your gullibility and naivete is normal - because you are an honest person.  One other thought you might want to consider.  The alternative to being gullible and naive may be worse - to become cynical, jaded and suspicious of everyone.



The Drugging of Abused Children

Foster children, traumatized by abuse and/or neglect, are frequently prescribed psychiatric medications at a much higher rate and at much higher doses than children in the general population.  But psychiatric medication is not the treatment for trauma, psychotherapy is.  

As these children grow up and age out of the foster care system, what will they have to say about their psychiatric treatment and the medications they were given?   

Documentary film makers Karen De Sa and Dai Sugano asked that very question in their film, "Drugging Our Kids".   The documentary examines the over-prescribing of psychiatric medications for children in California's foster care system.  The issues discussed in this film are not isolated to California.  Texas, the state in which I practice, has one of the highest rates of psychiatric medication prescribed for children in foster care.  This is a problem across the United States.   

The film examines the practice of using psychiatric medications as a chemical straight jacket to tranquilize problem behaviors.  I have seen the very long lists of medications prescribed to these children, as well as, the long lists of diagnoses that are given to them.  Rarely do these diagnoses contain Post-traumatic Stress Disorder (PTSD).  For children who have been removed from their homes due to abuse and neglect you would expect PTSD to be the primary diagnosis.  However, I more frequently saw;  ADHD, bipolar disorder, conduct disorder, oppositional behavior disorder, depression and anxiety disorders.  Rarely is consideration given that the behavior these children are exhibiting is most a result of the violence and neglect they have experienced.  They are simply labeled as behavior problems and medicated.  

Antidepressants May Cause Depression?

There's an interesting article on the CNCNews website discussing the lack of scientific research behind the chemical imbalance model for explaining depression.  

“And as early as 1998, the American Psychiatric Association in its textbook says we’re not finding that people with depression have any abnormality in their serotonin, but because it’s such an effective metaphor for getting people to take the drugs and sell the drugs, it’s continued to be promoted.”

Not only are antidepressants not effective, but taking them may actually exacerbate symptoms of depression...

"while people suffering from depression may not have low serotonin levels to begin with, the use of SSRIs reduces the brain’s capacity to produce serotonin on its own, leading to a worsening of symptoms when patients stop taking the drugs."

An interesting read indeed.




Learned Helplessness and Depression

While working with a depression support group it became apparent that many of the clients struggled with very negative ways of thinking about things and very negative ways of viewing the world.  This was interesting to me, because I battled depression myself for years.  I spent many years taking antidepressants without a significant relief from symptoms.  I eventually decided to stop and pay attention to the negative thinking in my own head.  As I researched it, I found it had a name:  Learned Helplessness.  

Learned helplessness is a concept developed by the psychologist, Martin Seligman.  Seligman worked with dogs who were exposed to electrical shocks.  Dogs who were allowed to push a button with their nose to stop the shocks learned to act to stop the shocks.  Dogs who were unable to escape the shocks learned to do nothing and wait for it to abate.  They gave up.  The conditioning taught the latter group they were unable to help themselves. 

This same behavior can be seen in some children and adults who endured traumatic childhoods.  Children who grow up in households where the parents' behavior is erratic and harmful will eventually stop trying to figure out a coping mechanism and just hunker down and endure the violence.  Imagine a child with a parent who is struggling with drug addiction.  Sometimes mom is unconscious, sometimes violent, sometimes pleasant.  The child never knows what they are going to get.  And the mother's behavior with the child is heavily influenced by the drugs, not the child.  What kind of behavior the mother displays depends on whether she; has drugs, is running out of drugs or is unable to get more drugs.  None of this is in the child's control.  And nothing the child tries to do to get the care they need from the mother will work if the mother is high from using drugs or raging because she can't find money to buy drugs.  So the child learns not to try to change their mother's behavior, because their efforts are futile.  Some of these children will space out or dissociate.  Some, like Seligman's dogs, will hunker down in the house and just endure the mother's abuse.  They learn they are helpless.  They learn not to try to change anything.

As adults they often adopt the same coping behavior.  They believe life is to be endured and feel they have no ability to act to change things.  Life is an endurance test, a series of mishaps that must be endured.  They can have a "Chicken Little" type of mentality, constantly feeling, "The sky is falling!  The sky is falling!"  These folks often view themselves as too helpless, too incompetent or too depressed to change the events in their life.  This creates a way of behaving and thinking that will result in pessimism and depression.  If this is the problem, medications will have little effect.  The problem is learned behavior, not biochemical. 

Finding that medications will not help can be disheartening.  But it can also be empowering.  A learned behavior can be unlearned.  The trick is to determine what the thinking is and learn how to think like a happier person does.

Seligman also studied naturally happy people and found the opposite of learned helplessness was learned optimism.  Seligman studied the differences between people who were basically pessimistic and people who were naturally optimistic and found three primary differences in their thinking patterns:  permanence, pervasiveness and personalization.  In a nutshell, optimistic people look at a failure as "I may have been thwarted at this goal (not their entire life), but it's a temporary setback (not a permanent failure) and it was just bad luck (nothing to do with them personally)".  


Learned Helplessness/PessimismLearned Optimism

Believe bad events are permanent

Believe good events are temporary

Believe bad events are temporary

Believe good events are permanent


Failure in one area means is interpreted as meaning they are a failure in their entire life or as a person in general.

Success, or happiness, in one area does not spill over into other areas.

Failure in one area does not mean they are a failure as a person or a failure in their life.  

Conversely, happiness in one arena may brighten all other areas.  


Blame themselves for bad events.

Attribute good events to external factors, i.e. "luck".

Take credit for good events.  

Blame bad events on external factors.

 Some people would say the optimist's outlook is not entirely realistic, and they would be right.  Research has shown that people struggling with depression more accurately assess the outcomes of events than people who are more optimist.   Happier people tend to incorrectly assume that things will be all right when they won't.

In the end, happiness may be the result of a little bit of self delusion.  But does that make it bad?



Narcissistic Rage: The Scorpion and the Frog

Once, there was a frog trying to cross a flooded river.   As he prepared to cross to the other side on a lily pad a scorpion asked to ride with him.  The frog responded, "If I let you go you still sting me."  The scorpion answered, "If I sting you we will both die.  Why would I do that?"  So the frog acquiesced and they boarded the lily pad.  Halfway across the scorpion stung the frog.  As the frog lay dying he pleaded, "Why on Earth did you sting me?  Now we will both die!"  The scorpion answered, "Because I'm a scorpion.  It's my nature."

We cannot change other people.  This is especially true if you are dealing with a narcissist.  Even knowing this, it's hard to grasp just how far they will go to hurt you when enraged.  Their behavior sometimes defies reason and reality.

I recently watched a narcissist who became so enraged at the "frog" in her life that she she stung herself to death trying to get at the frog.  Having destroyed herself, the frog and the entire lily pad she now sits in the wreckage which was her life, still trying to take shots at the frog.  Fortunately, in real life, the frog is usually able to get to shore and carry on with their lives.  But not without the narcissist's stings having taken their toll.  This is especially true if there are children involved.

What enraged this narcissist?  The fact that her partner saw through her facade.  He saw what she really was and therefore had to be destroyed.  Family members and friends tried to understand what he had done to her to make her so angry.  They interpreted her rage as hurt.  They were certain he had done something truly heinous.  But he hadn't.  He had merely seen reality.  He had seen the vacuum of her psyche, the absence of all the things which make us human;  the lack of empathy  for others, the absence of remorse when she hurt people, the lack of regard for any other person.  He saw what she really was, what she fought to cover up with a carefully contrived facade.  And for that the narcissist was determined to destroy him.  And and destroying him became more important than her own well being.  She utterly destroyed every good thing in her life, including herself, trying to get back at him.

Beware of narcissistic rage.  It can be fatal.